Management of lower limb fractures in patients with spinal cord injuries

• Published in: ANZ journal of surgery Vol. 90; no. 9; pp. 1743 - 1749
• Main Authors: Koong, Denis P., Symes, Michael J., Sefton, Andrew K., Sivakumar, Brahman S., Ellis, Andrew
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.09.2020; Blackwell Publishing Ltd
• Subjects: Australia - epidemiology; Complications; Demographics; Demography; Femur; fracture; Fracture Fixation, Intramedullary; Fractures; Fragility; Humans; Injuries; Intramedullary nails; knee; Lower Extremity; Middle Aged; Retrospective Studies; Spinal cord; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - epidemiology; Spinal Cord Injuries - therapy; spinal cord injury; tibia; Tibial Fractures - complications; Tibial Fractures - epidemiology; Tibial Fractures - surgery; trauma; Treatment Outcome; Australia; spinal cord injury; trauma; knee; tibia; femur; fracture
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15924

This is the first study in Australia to assess the orthopaedic management of lower extremity fragility fractures in patients with long‐standing spinal cord injuries. Lower limb fragility fractures in patients with spinal cord injuries can be managed successfully via either operative or non‐operative measures. In this series, fewer complications and shorter time to union were found in patients managed operatively. Background Low‐energy fractures of the lower limb in patients post spinal cord injury (SCI) present significant management challenges. This is the first Australian study to review the experience from a tertiary referral SCI centre and aims to identify trends and suggest therapeutic options. Methods Retrospective review over a 5‐year period in patients with SCI treated for a lower limb fragility fracture. Patient demographics, spinal injury severity scores, fracture characteristics and treatment were assessed. Time to union, length of stay and treatment‐related complications were also examined. Results A total of 38 SCI patients with 42 lower extremity fractures met inclusion criteria. Mean age was 55.7 years and mean duration post‐SCI at fracture was 22.5 ± 12.7 years. The femur (73.8%) was more commonly fractured than the lower leg (26.2%), with extra‐articular distal femoral fractures most prevalent (35.7%). A total of 25 (60%) fractures were managed operatively, and 17 (40%) non‐operatively. The majority of femoral fractures were managed with intramedullary nailing. Tibial fractures were more commonly managed non‐operatively. Eight cases (19.1%) experienced complications, with a significant difference between frequency of complications in non‐operative (35.3%) and operative (8.0%) groups; P = 0.045. All fractures united except one; time to union was shorter in patients treated surgically (13.6 ± 6.4 weeks) compared to those managed non‐operatively (19.1 ± 8.1 weeks). Conclusions Lower limb fragility fractures in patients with SCI can be managed successfully via either operative or non‐operative measures. In this series, fewer complications and shorter time to union were found in patients managed operatively.